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Schwarzman P, Sheiner E, Sergienko R, Kessous R. A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study. Arch Gynecol Obstet 2023; 308:499-505. [PMID: 35996034 DOI: 10.1007/s00404-022-06698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/22/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms. STUDY DESIGN A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991-2017 in a tertiary medical center. Kaplan-Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders. RESULTS During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16-1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03-1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14-3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies." When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01-1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9-2.8; p = 0.103). CONCLUSION Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.
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Affiliation(s)
- P Schwarzman
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
| | - E Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | - R Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - R Kessous
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
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2
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Cómitre-Mariano B, Martínez-García M, García-Gálvez B, Paternina-Die M, Desco M, Carmona S, Gómez-Gaviro MV. Feto-maternal microchimerism: Memories from pregnancy. iScience 2022; 25:103664. [PMID: 35072002 PMCID: PMC8762399 DOI: 10.1016/j.isci.2021.103664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
There is a bidirectional transplacental cell trafficking between mother and fetus during pregnancy in placental mammals. The presence and persistence of fetal cells in maternal tissues are known as fetal microchimerism (FMc). FMc has high multilineage potential with a great ability to differentiate and functionally integrate into maternal tissue. FMc has been found in various maternal tissues in animal models and humans. Its permanence in the maternal body up to decades after delivery suggests it might play an essential role in maternal pathophysiology. Studying the presence, localization, and characteristics of FMc in maternal tissues is key to understanding its impact on the woman's body. Here we comprehensively review the existence of FMc in different species and organs and tissues, aiming to better characterize their possible role in human health and disease. We also highlight several methodological considerations that would optimize the detection, quantification, and functional determination of FMc.
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Affiliation(s)
- Blanca Cómitre-Mariano
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Magdalena Martínez-García
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Instituto de Salud Carlos III, Pabellón 11, planta baja, 28029 Madrid, Spain
| | - Bárbara García-Gálvez
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - María Paternina-Die
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Instituto de Salud Carlos III, Pabellón 11, planta baja, 28029 Madrid, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Instituto de Salud Carlos III, Pabellón 11, planta baja, 28029 Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad, 30, 28911 Leganés, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III, CNIC, C/ Melchor Fernandez Almagro 3, 28029 Madrid, Spain
| | - Susanna Carmona
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Instituto de Salud Carlos III, Pabellón 11, planta baja, 28029 Madrid, Spain
| | - María Victoria Gómez-Gaviro
- Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), C/Doctor Esquerdo 46, 28007 Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Instituto de Salud Carlos III, Pabellón 11, planta baja, 28029 Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad, 30, 28911 Leganés, Spain
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Kinder JM, Jiang TT, Ertelt JM, Xin L, Strong BS, Shaaban AF, Way SS. Tolerance to noninherited maternal antigens, reproductive microchimerism and regulatory T cell memory: 60 years after 'Evidence for actively acquired tolerance to Rh antigens'. CHIMERISM 2015; 6:8-20. [PMID: 26517600 PMCID: PMC5063085 DOI: 10.1080/19381956.2015.1107253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Compulsory exposure to genetically foreign maternal tissue imprints in offspring sustained tolerance to noninherited maternal antigens (NIMA). Immunological tolerance to NIMA was first described by Dr. Ray D. Owen for women genetically negative for erythrocyte rhesus (Rh) antigen with reduced sensitization from developmental Rh exposure by their mothers. Extending this analysis to HLA haplotypes has uncovered the exciting potential for therapeutically exploiting NIMA-specific tolerance naturally engrained in mammalian reproduction for improved clinical outcomes after allogeneic transplantation. Herein, we summarize emerging scientific concepts stemming from tolerance to NIMA that includes postnatal maintenance of microchimeric maternal origin cells in offspring, expanded accumulation of immune suppressive regulatory T cells with NIMA-specificity, along with teleological benefits and immunological consequences of NIMA-specific tolerance conserved across mammalian species.
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Affiliation(s)
- Jeremy M Kinder
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Tony T Jiang
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - James M Ertelt
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Lijun Xin
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Beverly S Strong
- b Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Aimen F Shaaban
- b Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Sing Sing Way
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
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4
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Cirello V, Colombo C, Perrino M, De Leo S, Muzza M, Maffini MA, Fugazzola L. Fetal cell microchimerism in papillary thyroid cancer: A role in the outcome of the disease. Int J Cancer 2015; 137:2989-93. [DOI: 10.1002/ijc.29653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/17/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Valentina Cirello
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
| | - Carla Colombo
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Michela Perrino
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Simone De Leo
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Marina Muzza
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Maria Antonia Maffini
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Laura Fugazzola
- Endocrine Unit; , Fondazione IRCCS Ca' Granda; Milan Italy
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
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5
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Fetal microchimerism in kidney biopsies of lupus nephritis patients may be associated with a beneficial effect. Arthritis Res Ther 2015; 17:101. [PMID: 25889410 PMCID: PMC4416327 DOI: 10.1186/s13075-015-0615-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction Microchimeric male fetal cells (MFCs) have been associated with systemic lupus erythematosus, and published studies have further correlated MFC with lupus nephritis (LN). In the present study, we evaluated the frequency of MFC in the renal tissue of patients with LN. Methods Twenty-seven renal biopsies were evaluated: Fourteen were from women with clinical and laboratory findings of LN, and thirteen were from controls. Genomic DNA was extracted from kidney biopsies, and the male fetal DNA was quantified using real-time quantitative polymerase chain reactions for the detection of specific Y chromosome sequences. Results MFCs were detected in 9 (64%) of 14 of patients with LN, whereas no MFCs were found in the control group (P = 0.0006). No differences in pregnancy history were found between patients with LN and the control group. Significantly higher amounts of MFCs were found in patients with LN with serum creatinine ≤1.5 mg/dl. Furthermore, women with MFCs had significantly better renal function at the time of biopsy (P = 0.03). In contrast, patients with LN without MFCs presented with more severe forms of glomerulonephritis (World Health Organization class IV = 60% and class V = 40%). Conclusions Our data indicate a high prevalence of MFCs in renal biopsy specimens from women with LN, suggesting a role for MFCs in the etiology of LN. The present report also provides some evidence that MFCs could have a beneficial effect in this disease. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0615-4) contains supplementary material, which is available to authorized users.
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6
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Kinder JM, Jiang TT, Clark DR, Chaturvedi V, Xin L, Ertelt JM, Way SS. Pregnancy-induced maternal regulatory T cells, bona fide memory or maintenance by antigenic reminder from fetal cell microchimerism? CHIMERISM 2014; 5:16-9. [PMID: 24553046 DOI: 10.4161/chim.28241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Long-term maintenance of immune components with defined specificity, without antigen is the hallmark feature of immunological memory. However, there are fundamental differences in how memory CD8(+) compared with CD4(+) T cells are maintained. After complete antigen elimination, CD8(+) T cells can persist as a self-renewing numerically stable cell population, and therefore satisfy the most stringent definition of "memory." Comparatively, CD4(+) T cell maintenance is considerably less stable, often requiring low-level antigen persistence or antigenic reminders. Recent studies show these basic memory features, classically ascribed to effector CD8(+) and CD4(+) T cells, extend to immune suppressive Foxp3(+) regulatory CD4(+) T cells (Tregs). In particular, gestational expansion and postpartum retention of maternal Tregs with fetal specificity may explain the protective benefits of primary pregnancy on complications in subsequent pregnancy. Herein, the possibility of ongoing antigenic reminders from fetal cell microchimerism in postpartum maintenance of maternal Tregs with fetal specificity is considered.
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Affiliation(s)
- Jeremy M Kinder
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - Tony T Jiang
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - Dayna R Clark
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - Vandana Chaturvedi
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - Lijun Xin
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - James M Ertelt
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
| | - Sing Sing Way
- Division of Infectious Diseases; Cincinnati Children's Hospital Medical Center; Cincinnati, OH USA
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7
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Eisenberg RA, Via CS. T cells, murine chronic graft-versus-host disease and autoimmunity. J Autoimmun 2012; 39:240-7. [PMID: 22704961 PMCID: PMC3578438 DOI: 10.1016/j.jaut.2012.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 01/06/2023]
Abstract
The chronic graft-versus-host disease (cGVHD) in mice is characterized by the production of autoantibodies and immunopathology characteristic of systemic lupus erythematosus (lupus). The basic pathogenesis involves the cognate recognition of foreign MHC class II of host B cells by alloreactive CD4 T cells from the donor. CD4 T cells of the host are also necessary for the full maturation of host B cells before the transfer of donor T cells. CD8 T cells play critical roles as well. Donor CD8 T cells that are highly cytotoxic can ablate or prevent the lupus syndrome, in part by killing recipient B cells. Host CD8 T cells can reciprocally downregulate donor CD8 T cells, and thus prevent them from suppressing the autoimmune process. Thus, when the donor inoculum contains both CD4 T cells and CD8 T cells, the resultant syndrome depends on the balance of activities of these various cell populations. For example, in one cGVHD model (DBA/2(C57BL/6xDBA/2)F1, the disease is more severe in females, as it is in several of the spontaneous mouse models of lupus, as well as in human disease. The mechanism of this female skewing of disease appears to depend on the relative inability of CD8 cells of the female host to downregulate the donor CD4 T cells that drive the autoantibody response. In general, then, the abnormal CD4 T cell help and the modulating roles of CD8 T cells seen in cGVHD parallel the participation of T cells in genetic lupus in mice and human lupus, although these spontaneous syndromes are presumably not driven by overt alloreactivity.
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Affiliation(s)
- Robert A Eisenberg
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 756 BRB II/III, 421 Curie Blvd., Philadelphia, PA 19104-6160, USA.
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8
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Nelson JL. The otherness of self: microchimerism in health and disease. Trends Immunol 2012; 33:421-7. [PMID: 22609148 DOI: 10.1016/j.it.2012.03.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/06/2011] [Accepted: 03/24/2012] [Indexed: 12/19/2022]
Abstract
Microchimerism (Mc) refers to the harboring of a small number of cells (or DNA) that originated in a different individual. Naturally acquired Mc derives primarily from maternal cells in her progeny, or cells of fetal origin in women. Both maternal and fetal Mc are detected in hematopoietic cells including T and B cells, monocyte/macrophages, natural killer (NK) cells and granulocytes. Mc appears also to generate cells such as myocytes, hepatocytes, islet β cells and neurons. Here, the detrimental and beneficial potential of Mc is examined. The prevalence, diversity and durability of naturally acquired Mc, including in healthy individuals, indicates that a shift is needed from the conventional paradigm of 'self versus other' to a view of the normal 'self' as constitutively chimeric.
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Affiliation(s)
- J Lee Nelson
- Immunogenetics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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9
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Schnitzler M, Fisch P. A role for microchimerism in obesity and evolution? Med Hypotheses 2012; 78:528-32. [PMID: 22325989 DOI: 10.1016/j.mehy.2012.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 12/14/2011] [Accepted: 01/16/2012] [Indexed: 11/16/2022]
Abstract
Cells exchanged between individuals, such as those passing the placenta from the mother to the child and vice versa, may survive in the fetal or maternal circulation and tissues for decades and result in microchimerism. Microchimeric cells may play a role in tissue repair, but they have also been implicated as inducers of chronic inflammation, leading to autoimmunity or even cancer. Here we propose that microchimerism may play a more fundamental role in health and evolution by setting a limit to genomic variability within populations. This means that microchimerism allows immune recognition of genomic differences between donor and host which may, depending on the level of variability, cause chronic inflammation. Since chronic inflammation has been experimentally linked to metabolic syndrome, we propose that genomic variability could affect the individual's weight. Thus, metabolic syndrome, which is a growing health problem, may not only result from our lifestyle, but in part be caused by global migration and the increasingly diverse origin of the present human population. Moreover, since in nature weight gain is associated with an increased risk of predation, we discuss the possibility that immunological incompatibility normally promotes the continuous development of new species.
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Affiliation(s)
- Marc Schnitzler
- Department of Hematology and Oncology, Freiburg University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany.
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10
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Abstract
The development of the adaptive immune system has been studied in the mouse primarily because it is easier to access fetal tissues and because there exists a rich array of probes for analysis of various components of the immune system. While much has been learned from this exercise, it is also clear that different species show substantial temporal variation in the development of the immune system during early life. In mice, for instance, mature α/β T cells first appear in the periphery during the final stages of fetal gestation and only increase in number after birth (Friedberg and Weissman, 1974); in humans, on the other hand, the first mature α/β T cells are seen in peripheral tissues at 10-12 gestational weeks (g.w.) and are circulating in significant numbers by the end of the second trimester (Ceppellini et al., 1971; Haynes et al., 1988; Hayward and Ezer, 1974; Kay et al., 1970). Although the functional implications of these differences remain unclear, it is likely that there are significant biological consequences associated with the relatively early development of the peripheral adaptive immune system in humans, for example, with respect to the development of peripheral tolerance as well as to the response to antigens that might cross the placenta from the mother (e.g., cells bearing noninherited maternal alloantigens, infectious agents, food antigens, and the like). Here, we will review studies of immune system ontogeny in the mouse and in humans, and then focus on the possible functional roles of fetal T cell populations during development and later in life in humans.
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Affiliation(s)
- Jeff E Mold
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
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11
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The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. Clin Rev Allergy Immunol 2011; 40:42-9. [PMID: 20063186 DOI: 10.1007/s12016-009-8192-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite recent progress in the understanding of systemic lupus erythematosus (SLE), the striking 9:1 female to male ratio of disease incidence remains largely unexplained. In addition, peak SLE incidence rates occur during the early reproductive years in women. Studies which illuminate potential causes underlying this sex difference and characteristic onset during the reproductive years have the potential to fundamentally advance our understanding of disease pathogenesis in SLE. Similarly, progress in this area will likely inform human reproductive immunology. Studies of sex hormone function in the immune system are of obvious importance; however, it seems likely that many other types of sex-related genetic and immunological differences will contribute to SLE. In this review, we will focus on recent work in sex-related differences in cytokine pathways and genetics of these pathways as they relate to SLE pathogenesis. It seems quite possible that many of these sex-related differences could be important to reproductive fitness, which may explain the conservation of these immune system features and the observed female predominance of SLE.
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Abstract
Fetal cell microchimerism is defined as the persistence of fetal cells in the mother after birth without any apparent rejection. Fetal microchimeric cells (FMCs) engraft into the maternal bone marrow for decades after delivery and are able to migrate to blood and tissues. This phenomenon was hypothesized to have a detrimental role in autoimmune diseases, but data are still controversial and debated. In malignant tumors, fetal cell microchimerism has been postulated to have a positive effect on tumor burden, although some evidence suggests that FMCs may be involved in neoplastic progression. At the peripheral level, circulating FMCs are less frequently detected in patients with thyroid cancer, breast cancer or other solid, hematologic malignancies than in healthy individuals, which suggests a protective role for fetal cell microchimerism. In tissues, FMCs have been found in tumor sections from malignancies such as thyroid, breast, cervix, lung cancers and melanomas and have been shown to differentiate into epithelial, hematopoietic, endothelial and mesenchymal cells. FMCs with hematopoietic differentiation have been postulated to have a role in destroying the tumor, whereas mesenchymal and epithelial cells could participate in repair processes. Endothelial cells, on the other hand, are believed to play a part in tumor progression. This Review provides an overview of the role of fetal cell microchimerism in autoimmune and benign or malignant nonautoimmune diseases. Moreover, the mechanisms by which fetal cell microchimerism is believed to modulate the protection against cancer or tumor progression will be discussed, together with future research directions.
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Affiliation(s)
- Laura Fugazzola
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Università degli Studi di Milano, Via Francesco Sforza 35, 20122 Milan, Italy.
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13
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Jonsson AM, Papadogiannakis N, Granath A, Haggstrom J, Schaffer M, Uzunel M, Westgren M. Maternal microchimerism in juvenile tonsils and adenoids. Pediatr Res 2010; 68:199-204. [PMID: 20531252 DOI: 10.1203/pdr.0b013e3181eb2eb4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
During pregnancy small amounts of cells pass between the mother and the fetus, and this transfer may give rise to a chimeric state that persist for years in both individuals. Both fetal and maternal microchimerism (MMc) have been associated with different autoimmune disorders. Information about MMc in tissues of healthy individuals is sparse but is important when looking for maternal cells within affected tissues of certain diseases. The aim of this study was to investigate the occurrence of maternal cells in tonsils and adenoids of 20 healthy children between the ages of 2 and 15 years. All the children underwent surgery because of recurrent tonsillitis or respiratory obstruction. MMc was detected using an RT-PCR assay based on differences in gene polymorphisms between mother and child. We found maternal cells in the tonsils and/or adenoids in four of 20 children. This frequency is less than the frequency of maternal cells found in the peripheral blood of healthy adults but in agreement with the previously reported frequency of maternal chimerism in control tissues
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Affiliation(s)
- Anna Maria Jonsson
- Department of Obstetrics and Gynecology, Karolinska Institute and Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
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14
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Abstract
Non-self cells can circulate in the body of an individual after any sort of contact with an allogeneic source of cells, thus creating a situation of chimerism that can be transient or prolonged over time. This situation may appear after stem cell transplantation, pregnancy, transfusion or transplantation. Concerning transplantation, many hypotheses have been formulated regarding the existence, persistence and role of these circulating cells in the host. We will review the principal hypotheses that have been formulated for years since the first description of non-self circulating cells in mammals to the utilization of artificially induced chimerism protocols for the achievement of tolerance.
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Affiliation(s)
- Josep-Maria Pujal
- Translational Research Laboratory, Institut Català d'Oncologia, Hospital Duran i Reynals, Avda Gran Via s/n, Km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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15
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Dietert RR, Dietert JM, Gavalchin J. Risk of autoimmune disease: challenges for immunotoxicity testing. Methods Mol Biol 2010; 598:39-51. [PMID: 19967505 DOI: 10.1007/978-1-60761-401-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Autoimmunity represents a potentially diverse and complex category among the range of adverse outcomes for detection with immunotoxicity testing. For this reason, the risk of autoimmune disease is discussed in this overview chapter with additional mention among the later specific protocol chapters. Improvements in clinical diagnostic capabilities and disease recognition have led to a more accurate picture of the extent of autoimmune diseases across different human populations. While the risk of any single autoimmune disease remains modest when compared with that of lung or heart disease, the cumulative prevalence of autoimmune diseases is both significant and increasing. Autoimmune diseases are usually viewed in the context of the damaged tissue or organ (e.g., as a thyroid, gastrointestinal, cardiovascular or neurological disease). But improved recognition that underlying immune dysfunction can connect the risks for these as well as other diseases is critical for optimizing risk assessment. Since autoimmune diseases are chronic in nature with many first appearing in children or in young adults, these diseases exert a serious impact on both health care costs and quality of life. This chapter provides a discussion of the issues that should be considered with immunotoxicity testing for risk of autoimmunity.
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16
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Seeman MV. Mechanisms of sex difference: a historical perspective. J Womens Health (Larchmt) 2009; 18:861-6. [PMID: 19514828 DOI: 10.1089/jwh.2008.1208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The history of the discovery of mechanisms contributing to sex difference helps to better appreciate gender factors in a variety of disease states. The objective of this article is to illustrate four mechanisms of sex differences in disease incidence: X-linkage (including inactivation, escape from inactivating, skewed inactivation), sex-specific exposure to disease-producing pathogens, fetal microchimerism, and iron depletion. METHODS This is a historic review. RESULTS An emphasis on sex difference led to the uncovering of four different mechanisms by which illness rates differ in men and women. CONCLUSIONS Research into many disease states can benefit from a focus on potential mechanisms that yield sex differences in illness susceptibility, progression, and outcome.
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Affiliation(s)
- Mary V Seeman
- Centre for Addiction and Mental Health, Psychiatry, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
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Fugazzola L, Cirello V, Beck-Peccoz P. Fetal cell microchimerism in human cancers. Cancer Lett 2009; 287:136-41. [PMID: 19541407 DOI: 10.1016/j.canlet.2009.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 05/14/2009] [Accepted: 05/15/2009] [Indexed: 11/30/2022]
Abstract
The transfer of fetal cells into the maternal circulation occurs normally during pregnancy and the post-partum persistence of these cells in the maternal blood and tissues, known as fetal cell microchimerism, has been clearly demonstrated. However, the long-term consequences of this phenomenon are only beginning to be appreciated. In particular, whether microchimerism could be involved in the carcinogenetic process or whether fetal microchimeric cells could be able to differentiate in host tissues, participating in the maternal response to injury, is still matter of study. In this review, the possible role and the consequences of fetal cell microchimerism, as emerged from studies in animal models and in women with different types of cancer, will be presented.
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Affiliation(s)
- Laura Fugazzola
- Department of Medical Sciences, University of Milan and Endocrine Unit, Fondazione Policlinico IRCCS, Milan, Italy.
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Bronson PG, Ramsay PP, Thomson G, Barcellos LF. Analysis of maternal-offspring HLA compatibility, parent-of-origin and non-inherited maternal effects for the classical HLA loci in type 1 diabetes. Diabetes Obes Metab 2009; 11 Suppl 1:74-83. [PMID: 19143818 PMCID: PMC2635943 DOI: 10.1111/j.1463-1326.2008.01006.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Type 1 diabetes (T1D) is a complex trait for which variation in the classical human leucocyte antigen (HLA) loci within the Major Histocompatibility Complex (MHC) significantly influences disease risk. To date, HLA class II DR-DQ genes confer the strongest known genetic effect in T1D. HLA loci may also influence T1D through additional inherited or non-inherited effects. Evidence for the role of increased maternal-offspring HLA compatibility, and both parent-of-origin (POO) and non-inherited maternal HLA (NIMA) effects in autoimmune disease has been previously established. The current study tested hypotheses that classical HLA loci influence T1D through these mechanisms, in addition to genetic transmission of particular risk alleles. METHODS The Type 1 Diabetes Genetics Consortium (T1DGC) cohort was of European descent and consisted of 2271 affected sib-pair families (total n = 11 023 individuals). Class I genes HLA-A, Cw and B, and class II genes HLA-DRB1, DQA1, DQB1, DPA1 and DPB1 were studied. The pedigree disequilibrium test was used to examine transmission of HLA alleles to individuals with T1D. Conditional logistic regression was used to model compatibility relationships between mother-offspring and father-offspring for all HLA loci. POO and NIMA effects were investigated by comparing frequencies of maternal and paternal transmitted and non-transmitted HLA alleles for each locus. Analyses were also stratified by gender of T1D-affected offspring. RESULTS Strong associations were observed for all classical HLA loci except for DPA1, as expected. Compatibility differences between mother-offspring and father-offspring were not observed for any HLA loci. Furthermore, POO and NIMA HLA effects influencing T1D were not present. CONCLUSIONS Maternal-offspring HLA compatibility, POO and NIMA effects for eight classical HLA loci were investigated. Results suggest that these HLA-related effects are unlikely to play a major role in the development of T1D.
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Affiliation(s)
- P G Bronson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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O'Donoghue K. Fetal microchimerism and maternal health during and after pregnancy. Obstet Med 2008; 1:56-64. [PMID: 27582787 DOI: 10.1258/om.2008.080008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2008] [Indexed: 01/24/2023] Open
Abstract
Trafficking of fetal cells into the maternal circulation begins very early in pregnancy and the effects of this cell traffic are longlasting. All types of fetal cells, including stem cells, cross the placenta during normal pregnancy to enter maternal blood, from where they may be recovered in pregnancy for the purpose of genetic prenatal diagnosis. Fetal cells can also be located in maternal tissues during and after pregnancy, and persist as microchimeric cells for decades in marrow and other organs. Although persistent fetal cells were first implicated in autoimmune disease, subsequent reports routinely found microchimeric cells in healthy tissues and in non-autoimmune disease. Parallel studies in animal and human pregnancy now suggest instead that microchimeric fetal cells play a role in the response to tissue injury. However, it is still not clear whether microchimeric fetal cells persisting in the mother are an incidental finding, are naturally pathogenic or act as reparative stem cells, and the environmental or biological stimuli that determine microchimeric cell fate are as yet undetermined. Future studies must also focus on investigating whether fetal cells create functional improvement in response to maternal injury and whether this response can be manipulated. The pregnancy-acquired low-grade chimeric state of women could have far-reaching implications, influencing recovery after injury or surgery, ageing, graft survival after transplantation, survival after cancer as well as deciding the protective effect of pregnancy against diseases later in life. Lifelong persistence of fetal cells in maternal tissues may even explain why women live longer than men.
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Affiliation(s)
- Keelin O'Donoghue
- Department of Obstetrics and Gynaecology , University College Cork, Cork University Maternity Hospital , Wilton, Cork , Republic of Ireland
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Pujal JM, Gallardo D. PCR-based methodology for molecular microchimerism detection and quantification. Exp Biol Med (Maywood) 2008; 233:1161-70. [PMID: 18535170 DOI: 10.3181/0802-rm-35] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Peripheral blood microchimerism after pregnancy or solid organ transplantation has been widely studied, but a consensus on its detection has not yet been adopted. The objective of this study was to establish a panel of reproducible molecular polymerase chain reaction (PCR)-based methods for detection and quantification of foreign cells in an individual. We analyzed length polymorphisms generated by short tandem repeat (STR) and variable number tandem repeat (VNTR) markers. Human leukocyte antigen (HLA)-A and -B polymorphisms were detected by reference strand conformation analysis (RSCA). Class II polymorphisms on HLA-DRB1 locus were analyzed both by classical PCR-sequence-specific primers (SSP) and by quantitative PCR (Q-PCR). Also, sex-determining region-y gene (SRY) gene allowed specific male donor discrimination and quantification by Q-PCR in female recipients. Binomial statistical distribution analysis was used for each molecular technique to determine the number of PCR replicates of each sample. This analysis allowed the detection of the lowest detectable microchimerism level, when present. We could detect microchimerism in more than 96% and more than 86% of cases at levels as low as 1:10(5) and 1:10(6) donor per recipient cells (DPRC), respectively, using Q-PCR for SRY or for nonshared HLA-DRB1 alleles. These techniques allowed as low as 1 genome-equivalent cell detection. Lower levels (nanochimerism) could be detected but not quantified because of technique limitations. However, classical PCR methods allowed detection down to 1:10(4) DPRC for HLA-DRB1 PCR-SSP. The clinical application of these techniques in solid organ transplanted recipients showed microchimerism levels ranging from 1:10(4) to 1:10(6) DPRC after kidney or heart transplantation, and 1 log higher (1:10(3) to 1:10(6) DPRC) after liver transplantation. In conclusion, the standardization of molecular microchimerism detection techniques will allow for comparable interpretation of results in microchimerism detection for diagnostic or research studies.
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Affiliation(s)
- Josep-Maria Pujal
- Translational Research Laboratory, Institut Català d'Oncologia, Hospital Duran i Reynals, Avda Gran Via s/n, Km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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Megiorni F, Mora B, Bonamico M, Barbato M, Montuori M, Viola F, Trabace S, Mazzilli MC. HLA-DQ and susceptibility to celiac disease: evidence for gender differences and parent-of-origin effects. Am J Gastroenterol 2008; 103:997-1003. [PMID: 18177450 DOI: 10.1111/j.1572-0241.2007.01716.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Celiac disease (CD) is twice as frequent among female than male. Despite the large number of reports on the DQ2/DQ8 association, no systematic studies have investigated a possible different role of the HLA genes in the two genders. We performed case-control and family-based analyses of DR-DQ variants in a pediatric CD cohort with the aim of comparing female to male associations and to investigate the paternal/maternal inheritance of the disease-predisposing haplotypes. METHODS A total of 281 female and 156 male pediatric celiac patients, 292 nuclear families, and 551 controls were genotyped for HLA-DRB1, DQA1, and DQB1 loci. Odds ratio, parental origin of the disease-associated haplotypes, and transmission ratio distortion were evaluated in-between male and female cases. RESULTS DQ2/DQ8 were more frequent in female than in male patients (94% F, 85% M; P = 1.6 x 10(-3)) with a 99.1% and 90.5% calculated negative predictive value of the HLA test, respectively. Surprisingly, the majority of the 39 DQ2/DQ8 negative cases were male. The analysis of the DQ2 haplotype origin showed that 61% of female patients and 42% of male patients carried a paternal combination (P = 0.02). The transmission disequilibrium test (TDT) proved the major distortion in the DR3-DQ2 transmission from fathers to daughters. CONCLUSIONS CD is confirmed to be more prevalent in female than in male (F:M = 1.8) but, in DQ2/DQ8 negative patients, we found an unexpected male excess (F:M = 0.7). Moreover, only the inheritance of a paternal DQ2 haplotype led to a daughters predominance. These data show a role of HLA genes on the disease sex bias and suggest a possible different effect of parent-specific epigenetic modifications in the two genders.
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Affiliation(s)
- Francesca Megiorni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Early Hematopoietic Microchimerism Predicts Clinical Outcome After Kidney Transplantation. Transplantation 2007; 84:1103-11. [PMID: 17998864 DOI: 10.1097/01.tp.0000286172.57076.df] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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